U.S. patent number 11,096,610 [Application Number 15/892,551] was granted by the patent office on 2021-08-24 for surgical implants including sensing fibers.
This patent grant is currently assigned to COVIDIEN LP. The grantee listed for this patent is Covidien LP. Invention is credited to Seok Joo Chang, Hoon Cho, Clifford L. Emmons.
United States Patent |
11,096,610 |
Emmons , et al. |
August 24, 2021 |
Surgical implants including sensing fibers
Abstract
A monitoring system includes a surgical implant configured for
implantation in vivo and having at least one sensing fiber
configured to measure a preselected physiological parameter, and a
receiving unit in wireless communication with the at least one
sensing fiber and configured to receive measurements of the
preselected physiological parameter. A surgical system includes an
end effector having a plurality of fasteners, and a surgical
implant securable to tissue via the plurality of fasteners. The
surgical implant includes at least one sensing fiber configured to
measure a preselected physiological parameter.
Inventors: |
Emmons; Clifford L. (Dennis,
MA), Chang; Seok Joo (Seoul, KR), Cho; Hoon
(Seoul, KR) |
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
MA |
US |
|
|
Assignee: |
COVIDIEN LP (Mansfield,
MA)
|
Family
ID: |
1000005759123 |
Appl.
No.: |
15/892,551 |
Filed: |
February 9, 2018 |
Prior Publication Data
|
|
|
|
Document
Identifier |
Publication Date |
|
US 20180279925 A1 |
Oct 4, 2018 |
|
Related U.S. Patent Documents
|
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|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
62599232 |
Dec 15, 2017 |
|
|
|
|
62477458 |
Mar 28, 2017 |
|
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
5/1459 (20130101); A61B 17/07292 (20130101); A61B
90/06 (20160201); A61B 5/076 (20130101); A61B
5/14539 (20130101); A61B 5/686 (20130101); A61B
2017/07257 (20130101); A61B 2017/07271 (20130101); A61B
2017/00026 (20130101); A61B 2017/00035 (20130101); A61B
2562/0233 (20130101); A61B 2090/064 (20160201); A61B
17/1155 (20130101); A61B 17/07207 (20130101); A61B
2017/00221 (20130101); A61B 2017/00084 (20130101); A61B
5/14546 (20130101) |
Current International
Class: |
A61B
17/072 (20060101); A61B 5/07 (20060101); A61B
5/1459 (20060101); A61B 90/00 (20160101); A61B
5/00 (20060101); A61B 5/145 (20060101); A61B
17/115 (20060101); A61B 17/00 (20060101) |
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Primary Examiner: Winakur; Eric F
Assistant Examiner: Fardanesh; Marjan
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of, and priority to, U.S.
Provisional Patent Application Ser. No. 62/599,232, filed on Dec.
15, 2017 and U.S. Provisional Patent Application Ser. No.
62/477,458, filed on Mar. 28, 2017, the entire content of which is
hereby incorporated by reference herein.
Claims
What is claimed is:
1. A surgical system comprising: an end effector including a
plurality of fasteners; and a surgical implant securable to tissue
via the plurality of fasteners of the end effector, the surgical
implant including at least one sensing fiber configured to measure
a preselected physiological parameter, the at least one sensing
fiber including a semiconducting element, an insulating element,
and a plurality of conducting elements electrically connected in a
circuit.
2. The surgical system according to claim 1, wherein the at least
one sensing fiber of the surgical implant includes a core and a
sheath disposed over the core.
3. The surgical system according to claim 2, wherein the core
includes the semiconducting element, the plurality of conducting
elements, and the insulating element.
4. The surgical system according to claim 2, wherein the core
includes the semiconducting element and the plurality of conducting
elements in contact with the semiconducting element.
5. The surgical system according to claim 1, wherein the surgical
implant is a surgical buttress releasably attached to the end
effector.
6. The surgical system according to claim 1, wherein the surgical
implant is a surgical mesh including the at least one sensing fiber
including a plurality of fibers.
7. The surgical system according to claim 1, wherein the plurality
of conducting elements are electrodes.
8. The surgical system according to claim 1, further comprising a
receiving unit in wireless communication with the at least one
sensing fiber and configured to receive measurements of the
preselected physiological parameter.
9. The surgical system according to claim 1, wherein the at least
one sensing fiber is wireless and externally powered.
Description
BACKGROUND
Technical Field
The present disclosure relates to surgical implants including
sensing fibers for post-operative monitoring. Embodiments of the
present disclosure relate to surgical buttresses that are
releasably attached to a surgical stapling apparatus, and in
particular, to a surgical buttress including sensing fibers for
detecting tissue conditions along a staple line and transmitting
the tissue conditions to a remote device. Embodiments of the
present disclosure relate to a surgical mesh including sensing
fibers for detecting tissue conditions at a soft tissue repair site
and transmitting the tissue conditions to a remote device.
Background of Related Art
Surgical stapling apparatus are employed by surgeons to
sequentially or simultaneously apply one or more rows of fasteners,
e.g., staples or two-part fasteners, to body tissue for the purpose
of joining segments of body tissue together and/or attaching a
surgical implant to body tissue. Such apparatus generally include a
pair of jaws or finger-like structures between which the body
tissue to be joined is placed. When the stapling apparatus is
actuated, or "fired", longitudinally moving firing bars contact
staple drive members in one of the jaws. The staple drive members
push the surgical staples through the body tissue and into an anvil
in the opposite jaw which forms the staples. If tissue is to be
removed or separated, a knife blade can be provided in the jaws of
the apparatus to cut the tissue between the lines of staples.
Surgical supports, e.g., meshes or buttress materials, may be used
in combination with surgical stapling apparatus to bridge, repair
and/or reinforce tissue defects within a patient such as those
occurring, for example, in the abdominal wall, chest wall,
diaphragm, or musculo-aponeurotic areas of the body. A buttress
material may reinforce a staple or suture line as well as cover the
juncture of tissues to reduce leakage prior to healing. A mesh or
patch may reinforce, replace, and/or augment soft tissue such as,
the abdominal wall in the case of hernia repair.
For example, following surgery on the gastrointestinal system in
which the bowel undergoes anastomosis, a possibility exists that an
incidence may arise/develop of subsequent leakage from the bowel
into the peritoneal cavity. The result of this development (e.g.,
impacts on morbidity and mortality) dramatically affects the
patient's prognosis and largely impacts the cost of treatment. Leak
detection is generally accomplished by monitoring clinical signs of
infection, including white blood cell count, fever, malaise, heart
rate, etc. A factor of using clinical signs is that there is a lag
between the time the leak occurs and the onset of signs or
symptoms. This may result in an escalation of the condition prior
to its detection and the appropriate treatment being
instituted.
Imaging modalities, such as fluoroscopy, may be utilized to monitor
for leak detection after administering radiopaque dye orally or
rectally. Imaging modalities, however, have limitations of
sensitivity and specificity, and require significant resources and
cost to perform. Additional leak detection attempts of measuring
effluent from drains have demonstrated some success. Limitations of
this approach, however, include the inconsistent use of drains due
to concomitant effects (e.g., infection, clogging, migration, etc.)
and identification of markers from drain fluid may be delayed
significantly after the leak occurs.
As another example, post-surgical complications may arise after an
abdominal wall hernia repair procedure. The performance of a hernia
repair using a mesh fixed to an abdominal wall depends, in part,
upon shear forces exerted upon the mesh and/or experienced at
fixation points of the mesh to tissue due to, for example, changes
in intra-abdominal pressure. Tearing, breakage, and/or bulging of
the mesh may compromise the surgical repair of the hernia defect,
or lead to mesh failure.
While devices and methods are available in attempts of identifying
post-surgical complications, such as leaks and/or implant
compromise, it would be advantageous to provide a real time
non-invasive monitoring system for effective early detection of
issues associated with a patient's health. Such a system would
provide a clinician with a method of evaluating critical predictors
of morbidity and mortality in patients in real time following
surgery and/or tissue trauma. Acute stage detection would allow for
early intervention resulting in improved patient outcomes.
Additionally or alternatively, it would be advantageous to include
a real time monitoring system as part of a post-operative regimen
for improving patient recovery following surgical trauma and/or
stress.
SUMMARY
A monitoring system in accordance with aspects of the present
disclosure includes a surgical implant configured for implantation
in vivo and having at least one sensing fiber configured to measure
a preselected physiological parameter, and a receiving unit in
wireless communication with the at least one sensing fiber and
configured to receive measurements of the preselected physiological
parameter.
The surgical implant may include a porous layer, and the at least
one sensing fiber may be disposed within the porous layer. The
surgical implant may be formed from a plurality of fibers, and the
at least one sensing fiber may be incorporated into the plurality
of fibers. The surgical implant may include a non-porous layer, and
the at least one sensing fiber may be disposed within the
non-porous layer.
In some aspects, the at least one sensing fiber is an optical
fiber. In certain aspects, the preselected physiological parameter
measured by the at least one sensing fiber is pH, in some other
aspects, the preselected physiological parameter measured by the at
least one sensing fiber is a quantity of an analyte, and in yet
other aspects, the preselected physiological parameter measured by
the at least one sensing fiber is force.
The at least one sensing fiber may include a core and a sheath
disposed over the core. The core may include a semiconducting
element, a conducting element, and an insulating element. In some
aspects, the core includes a semiconducting element and a plurality
of conducting elements in contact with the semiconducting element.
In certain aspects, the plurality of conducting elements is
electrically connected in a circuit.
A surgical system in accordance with aspects of the present
disclosure includes an end effector having a plurality of fasteners
and a surgical implant securable to tissue via the plurality of
fasteners. The surgical implant includes at least one sensing fiber
configured to measure a preselected physiological parameter.
In some aspects, the at least one sensing fiber is an optical
sensor. The at least one sensing fiber may include a core and a
sheath disposed over the core. The core may include a
semiconducting element, a conducting element, and an insulating
element. In some aspects, the core includes a semiconducting
element and a plurality of conducting elements in contact with the
semiconducting element. In certain aspects, the plurality of
conducting elements is electrically connected in a circuit.
The surgical implant may be a surgical buttress releasably attached
to the end effector. The surgical implant may be a surgical mesh
including a plurality of fibers.
A surgical stapling apparatus in accordance with aspects of the
present disclosure includes an end effector having a staple
cartridge assembly and an anvil assembly, and a surgical buttress
releasably attached to the staple cartridge assembly or the anvil
assembly. The surgical buttress includes at least one sensing fiber
configured to measure a preselected physiological parameter.
The surgical buttress may include a porous layer in which the at
least one sensing fiber is disposed and/or a non-porous layer in
which the at least one sensing fiber is disposed. In some aspects,
the at least one sensing fiber is an optical sensor. In certain
aspects, the preselected physiological parameter measured by the at
least one sensing fiber is pH.
The at least one sensing fiber of the surgical buttress may include
a core and a sheath disposed over the core. The core may include a
semiconducting element, a conducting element, and an insulating
element. In some aspects, the core includes a semiconducting
element and a plurality of conducting elements in contact with the
semiconducting element. In certain aspects, the plurality of
conducting elements is electrically connected in a circuit.
A monitoring system in accordance with aspects of the present
disclosure includes a surgical buttress and a receiving unit. The
surgical buttress is configured for implantation in vivo and
includes at least one sensing fiber configured to measure a
preselected physiological parameter. The receiving unit is in
wireless communication with the at least one sensing fiber and
configured to receive measurements of the preselected physiological
parameter.
The surgical buttress may include a porous layer in which the at
least one sensing fiber is disposed and/or a non-porous layer in
which the at least one sensing fiber is disposed. In some aspects,
the at least one sensing fiber is an optical sensor. In certain
aspects, the preselected physiological parameter measured by the at
least one sensing fiber is pH.
The at least one sensing fiber of the surgical buttress may include
a core and a sheath disposed over the core. The core may include a
semiconducting element, a conducting element, and an insulating
element. In some aspects, the core includes a semiconducting
element and a plurality of conducting elements in contact with the
semiconducting element. In certain aspects, the plurality of
conducting elements is electrically connected in a circuit.
A method of in vivo monitoring of an anastomosis in real time
includes: securing a surgical buttress to tissue, the surgical
buttress including at least one sensing fiber configured to measure
a preselected physiological parameter; and monitoring the
preselected physiological parameter via data wirelessly received by
a receiving unit from the at least one sensing fiber of the
surgical buttress. In aspects, the method further includes:
positioning a body portion of a surgical stapling device including
a staple cartridge assembly adjacent a first tissue and positioning
an anvil assembly of the surgical stapling device adjacent a second
tissue, the staple cartridge assembly or the anvil assembly
including the surgical buttress releasably retained thereon; and
firing the surgical stapling device to mechanically secure the
surgical buttress and the first and second tissues with staples
from the staple cartridge assembly along a staple line.
Other aspects, features, and advantages will be apparent from the
description, drawings, and the claims.
BRIEF DESCRIPTION OF THE DRAWINGS
Various aspects of the present disclosure are described herein
below with reference to the drawings, which are incorporated in and
constitute a part of this specification, wherein:
FIG. 1 is a top view of a surgical implant in accordance with an
embodiment of the present disclosure;
FIG. 2 is a side view of a surgical implant in accordance with
another embodiment of the present disclosure;
FIG. 3 is a schematic illustration of a monitoring system including
a sensing fiber of the surgical implant of FIG. 1 or FIG. 2, and a
receiving unit in accordance with an embodiment of the present
disclosure;
FIG. 4 is a perspective view of a surgical stapling apparatus
including a surgical buttress disposed on an anvil assembly of the
surgical stapling apparatus and a surgical buttress disposed on a
staple cartridge assembly of the surgical stapling apparatus in
accordance with an embodiment of the present disclosure;
FIG. 5 is a perspective view of a distal end of the surgical
stapling apparatus of FIG. 4, shown in use and positioned about
tissue;
FIG. 6 is a cross-sectional view of the distal end of the surgical
stapling apparatus of FIGS. 4 and 5, taken along line 6-6 of FIG.
5;
FIG. 7 is a perspective view of the stapled and divided tissue of
FIG. 6;
FIG. 8 is a perspective view of a surgical stapling apparatus in
accordance with another embodiment of the present disclosure;
FIG. 9 is a cross-sectional view of the surgical stapling apparatus
of FIG. 8 including a surgical buttress disposed on an anvil
assembly of the surgical stapling apparatus and a surgical buttress
disposed on a staple cartridge assembly of the surgical stapling
apparatus in accordance with an embodiment of the present
disclosure;
FIG. 10 is a top view of one of the surgical buttresses of FIG. 9;
and
FIG. 11 is a top view of a surgical mesh in accordance with an
embodiment of the present disclosure, shown secured to tissue via
surgical staples.
DETAILED DESCRIPTION OF THE EMBODIMENTS
The present disclosure is directed to surgical implants, systems,
and methods of using the same for measuring physiological
parameters in real time. The physiological parameters may be
associated with acute and/or chronic tissue compromise or failure
in one or multiple tissue/organ sites. The present disclosure
describes embodiments of surgical implants for real time monitoring
of physiological parameters, surgical stapling apparatus supporting
and/or securing said surgical implants to tissue, monitoring
systems including said surgical implants and a receiving unit for
analysis of the physiological parameters, and exemplary
corresponding methods of use in accordance with principles of the
present disclosure.
The presently disclosed surgical implants may be any medical
device, such as scaffolds, grafts, patches, slings, pledgets,
growth matrices, drug delivery devices, wound plugs, and, in
general, may be soft tissue repair devices and/or surgical
prostheses. It should be understood that the surgical implants may
also be utilized as topically applied medical products, such as
wound dressings, coverings, and the like, that can be used in
medical/surgical procedures. The principles of the present
disclosure are related to monitoring of surgical and medical
treatments of disease and body ailments of a patient, such as
necrosis, infection, and cancer. For example, devices, systems, and
methods of the present disclosure may be utilized in the detection
of infection, metabolic disorder, or abnormal or non-ideal
conditions of wound healing.
Embodiments of the presently disclosed surgical implants will now
be described in detail with reference to the drawing figures
wherein like reference numerals identify similar or identical
elements. Throughout this description, the term "proximal" refers
to a portion of a structure, or component thereof, that is closer
to a clinician, and the term "distal" refers to a portion of the
structure, or component thereof, that is farther from the
clinician. As used herein, the term "patient" should be understood
as referring to a human subject or other animal, and the term
"clinician" should be understood as referring to a doctor, nurse,
or other care provider and may include support personnel.
Referring now to FIG. 1, a surgical implant 10 in accordance with
the present disclosure is shown. The surgical implant 10 may have
any shape, size, and/or dimension suitable for its intended
application as should be understood by those skilled in the art.
The surgical implant 10 is fabricated from biocompatible materials
which are bioabsorbable or non-absorbable, natural or synthetic
materials. It should be understood that any combination of natural,
synthetic, bioabsorbable, and/or non-bioabsorbable materials may be
used to form the surgical implant 10.
The surgical implant 10 may be porous, non-porous, or combinations
thereof. Suitable porous structures include, for example, fibrous
structures (e.g., knitted structures, woven structures, and
non-woven structures) and/or foams (e.g., open or closed cell
foams). Suitable non-porous structures include, for example, films.
The surgical implant 10 described herein may be a single porous or
non-porous layer, or include a plurality of layers including any
combination of porous and non-porous layers. For example, a
surgical implant may include multiple porous and non-porous layers
that are stacked in an alternating manner. In another example, a
surgical implant may be formed in a "sandwich-like" manner wherein
the outer layers of the surgical implant are porous and the inner
layer(s) are non-porous.
Porous layer(s) in the surgical implant may enhance the ability of
the surgical implant to absorb fluid, reduce bleeding, and seal the
wound. Also, the porous layer(s) may allow for tissue ingrowth to
fix the surgical implant in place. Non-porous layer(s) in the
surgical implant may enhance the ability of the surgical implant to
resist tears and perforations during the manufacturing, shipping,
handling, and securing (e.g., stapling) processes. Also, non-porous
layer(s) may retard or prevent tissue ingrowth from surrounding
tissues thereby acting as an adhesion barrier and preventing the
formation of unwanted scar tissue.
As shown in FIG. 1, the surgical implant 10 includes a single
porous layer 12 having a fibrous structure. The porous layer 12 is
formed from a plurality of interconnected fibers 14. The fibers 14
may be biocompatible polymeric and/or metallic materials in the
form of filaments, threads, and/or yarns that are, for example,
knitted or woven together, or may be staple fibers such as those
used for preparing non-woven materials. Suitable techniques for
assembling the fibers 14 are within the purview of those skilled in
the art. The porous layer 12 of the surgical implant 10 further
includes one or more sensing fibers 20 assembled with the fibers
14, or otherwise incorporated into the porous layer 12 of the
surgical buttress 10, in a desired configuration based on, for
example, in vivo sensing needs.
As discussed above, the surgical implant 10 may have other
configurations. For example, as shown in FIG. 2, a surgical implant
10a includes a porous layer 12a and a non-porous layer 12b. Sensing
fiber(s) 20 may be disposed in either or both the porous and
non-porous layers 12a, 12b. It should be understood that at least
one sensing fiber 20 is associated with a surgical implant 10, 10a
and that the sensing fiber(s) may be disposed within a porous layer
(e.g., fibrous structure or foam), a non-porous layer (e.g., a
film), or combinations thereof depending on the configuration of
the surgical implant 10, 10a.
Referring now to FIG. 3, the sensing fiber 20 is a sensor
configured to measure a preselected physiological parameter of
interest and to transmit signals relating to the physiological
parameter to a receiving unit 30. The preselected physiological
parameter may be a mechanical characteristic (e.g., relaxation,
creep, etc.) of the tissue to which the surgical implant 10, 10a
(FIGS. 1-2, respectively) is secured, or a substance (e.g.,
analytes, biomarkers, etc.) in the tissue and/or the tissue
environment indicative of a physiological condition or state such
as, for example, tissue perfusion, tissue ischemia, tissue
reperfusion, infection, etc.
The sensing fiber 20 may be: an optical or electrical sensor for
measuring characteristics such as impedance, temperature, pH, the
presence and/or level of analytes, etc.; a mechanical sensor for
measuring, for example, characteristics such as force, stress,
strain, etc.; a conductivity or resistivity sensor for measuring,
for example, ionic concentration of a compound; among other sensors
within the purview of those skilled in the art for physical or
chemical sensing. It should be understood that a surgical implant
10, 10a may include multiple sensing fibers 20 that measure the
same or different characteristics.
With continued reference to FIG. 3, the sensing fiber 20 includes a
core 22 configured to measure and transmit signals related to the
preselected physiological parameter to the receiving unit 30, and a
sheath 24 disposed over the core 22. While the sensing fiber 20 is
shown having a circular cross-section, it should be understood that
the sensing fiber 20 may have other cross-sectional shapes such as,
for example, elliptical, triangular, and rectangular, among other
regular and irregular shapes. Additionally, it should be understood
that the core 22 may be off-center with respect to the sheath 24 or
a plurality of cores 22 may be disposed within the sheath 24 such
that the sensing fiber 20 exhibits an islands-in-the-sea
arrangement where two or more "islands" (e.g., cores) are
surrounded by a "sea" (e.g., sheath).
The core 22 includes one or more semiconducting elements 22a for
measuring the physiological parameter, one or more conducting
elements 22b (e.g., electrodes) connected in a circuit, and one or
more insulating elements 22c disposed between and/or around the
semiconducting and/or conducting elements 22a, 22b. The
semiconducting element(s) 22a of the core 22 may be formed from a
chalcogenide glass, the conducting element(s) 22b of the core 22
may be formed from a metal or metal alloy, and the insulating
element(s) 22c of the core 22 and/or the sheath 24 may be formed,
for example, from a thermoplastic polymer or copolymer such as
polyetherether ketone, polyetherimide, polyether sulfone,
polysulfone, polycarbonate, polyethylene, polymethyl methacrylate,
or polytetrafluoroethylene.
The semiconducting, conducting, and insulating elements 22a, 22b,
22c are configured in a specific geometry (e.g., with selected
material interfaces) during fabrication of the sensing fiber 20 to
enable a desired sensing functionality. Accordingly, it should be
understood that the core 22 of the sensing fiber 20 may have any of
a variety of configurations (e.g., the core 22 can be solid or
include spaces or gaps, may be symmetrical or non-symmetrical,
etc.).
The sensing fiber 20 is wireless and may be powered externally via,
e.g., radiofrequency or magnetic telemetry, to run continuously or
be activated intermittently. The receiving unit 30 is an
extracorporeal device configured to communicate with the sensing
fiber 20 via a wireless (e.g., radiofrequency, optical, WiFi,
Bluetooth.RTM., LTE, etc.) connection to collect the signals from
the sensing fiber 20 in real time and to process the signals into
digital data. The receiving unit 30 may be a portable electronic
device which may be worn by a patient (e.g., a wristwatch or
transcorporeal patch), or otherwise carried by the patient (e.g., a
mobile device such as a cell phone, or a unit disposed within a
carrying case) to allow for patient mobility during post-surgical
monitoring.
The signals/data collected by the receiving unit 30 may also be
sent to a mobile device of a clinician or be transmitted to a cloud
such that a clinician can access the information. The receiving
unit 30 may provide a sensor alert via an indicator (e.g., a
visual, audio, or other sensory indicator) to the patient and/or a
clinician when a predetermined test criterion is met to allow for
appropriate medical response based on the information received. The
signals produced by the sensing fiber 20 contain information about
a specific characteristic of the tissue and/or tissue environment
which, in turn, imparts information about a condition or state of
the tissue which can be utilized in determining a proper course of
treatment.
With reference now to FIGS. 4-10, various exemplary embodiments of
the surgical implants of the present disclosure are discussed in
terms of surgical buttresses for use with surgical stapling
apparatus. While these embodiments are directed to the detection of
leaks of gastrointestinal content into the abdomen following
anastomosis, it is envisioned that the principles of the present
disclosure are equally applicable to a range of in vivo diagnostic
applications, as discussed above.
The surgical buttresses may be used in sealing a wound by
approximating the edges of wound tissue between a staple cartridge
assembly and an anvil assembly of a surgical stapling apparatus
which includes at least one surgical buttress having sensing
fiber(s). The surgical buttress is releasably attached to the
surgical stapling apparatus such that staples fired from the
surgical stapling apparatus attach the surgical buttress to tissue.
The sensing fibers of the surgical buttress measure a physiological
parameter of the tissue and/or tissue environment and transmit the
data to a receiving unit for monitoring by a clinician or the
patient.
It should be understood that a variety of surgical stapling
apparatus may be utilized with a surgical buttress of the present
disclosure. For example, linear staplers may be utilized, such as,
for example those including Duet TRS.TM. reloads and staplers with
Tri-Staple.TM. technology, available through Medtronic, formerly
Covidien (North Haven, Conn.), as well as other anastomosis
staplers, such as, for example, EEA.TM., CEEA.TM., GIA.TM.,
EndoGIA.TM., and TA.TM., also available through Medtronic. It
should also be appreciated that the principles of the present
disclosure are equally applicable to surgical staplers having a
variety of configurations, such as, for example, end-to-end
anastomosis staplers having a circular cartridge and anvil (see,
e.g., commonly owned U.S. Pat. No. 5,915,616, entitled "Surgical
Fastener Applying Apparatus," the entire content of which is
incorporated herein by this reference); laparoscopic staplers (see,
e.g., commonly owned U.S. Pat. Nos. 6,330,965 and 6,241,139, each
entitled "Surgical Stapling Apparatus," the entire contents of each
of which being incorporated herein by this reference); and
transverse anastomosis staplers (see, e.g., commonly owned U.S.
Pat. Nos. 5,964,394 and 7,334,717, each entitled "Surgical Fastener
Applying Apparatus", the entire contents of each of which being
incorporated herein by this reference).
It is additionally appreciated that the principles of the present
disclosure are equally applicable to powered handheld
electromechanical surgical staplers having a variety of
configurations, such as, for example, those shown and described in
U.S. Patent Application Publication No. 2015/0297199, the entire
contents of each of which is incorporated herein by this
reference).
Referring now to FIG. 4, an exemplary surgical stapling apparatus
or surgical stapler 100 is shown for use in stapling tissue and
applying a surgical implant in the form of a buttress material or
surgical buttress 11 to the tissue. The surgical stapling apparatus
100 generally includes a handle assembly 110, an elongate tubular
body portion 120 extending distally from the handle assembly 110,
and an end effector or jaw assembly 130 extending distally from the
elongate tubular body portion 120. The jaw assembly 130 includes an
anvil assembly 140 including a staple clinching anvil jaw member
142 and a staple cartridge assembly 150 including a cartridge
receiving jaw member 152 housing a staple cartridge 154. The jaw
assembly 130 may be permanently affixed to the elongate tubular
body portion 120 or may be detachable with respect to the elongate
tubular body portion 120 and thus, replaceable with a new jaw
assembly 130. Additionally or alternatively, the staple cartridge
154 may be removable and replaceable in the receiving jaw member
152 of the staple cartridge assembly 150. The anvil assembly 140 is
pivotable with respect to the elongate tubular body portion 120 and
is movable between an open position spaced apart from the staple
cartridge assembly 150 and a closed position substantially adjacent
the staple cartridge assembly 150. It is envisioned that,
additionally or alternatively, the staple cartridge assembly 150
may be pivotable with respect to the elongate tubular body portion
120.
The surgical stapling apparatus 100 further includes a trigger 112
movably mounted on the handle assembly 110. Actuation of the
trigger 112 initially operates to move the anvil assembly 140 from
the open position to the closed position relative to staple
cartridge assembly 150 and subsequently actuates the surgical
stapling apparatus 100 to apply lines of staples to tissue captured
between the anvil and staple cartridge assemblies 140, 150.
Specifically, a driver 116 is provided to move the anvil jaw member
142 between the open and closed positions relative to the receiving
jaw member 152. The driver 116 moves between a longitudinal slot
141 formed in the anvil jaw member 142, and a knife 118 (FIG. 6)
associated with the driver 116 cuts tissue captured between the
anvil and staple cartridge assemblies 140, 150 as the driver 116
passes through the longitudinal slot 141 of the anvil jaw member
142, as described in further detail below.
In order to properly orient the jaw assembly 130 relative to the
tissue to be stapled, the surgical stapling apparatus 100 includes
a rotation knob 114 mounted on the handle assembly 110. Rotation of
the rotation knob 114 relative to the handle assembly 110 rotates
the elongate tubular body portion 120 and the jaw assembly 130
relative to the handle assembly 110 so as to properly orient the
jaw assembly 130 relative to the tissue to be stapled.
With continued reference to FIG. 4, respective surgical buttresses
11 are releasably attached to tissue facing surfaces (not
explicitly shown) of the anvil assembly 140 and the staple
cartridge assembly 150. The surgical buttress 11 may be releasably
attached to the anvil assembly 140 and/or the staple cartridge
assembly 150 via any suitable attachment feature within the purview
of those skilled in the art, such as chemical attachment features
(e.g., adhesives) and mechanical attachment features (e.g.,
mounting structures, such as pins or straps). The surgical buttress
11 is provided to reinforce and seal staple lines applied to tissue
by the surgical stapling apparatus 100 and to measure a preselected
physiological parameter of the tissue and/or the tissue
environment.
It should be understood that while the surgical buttresses 11 are
shown and described herein as being associated with both the anvil
assembly 140 and the staple cartridge assembly 150, the surgical
buttresses may be the same or different, or may only be associated
with either the anvil assembly or the staple cartridge assembly,
depending on, for example, the surgical application and/or desired
placement and monitoring as should be understood by a person of
ordinary skill in the art.
The surgical buttress 11 may have any shape, size, and/or dimension
suitable to fit a surgical stapling apparatus. The surgical
buttress is fabricated from biocompatible material(s) and may be
porous, non-porous, or combinations thereof, as discussed above.
The surgical buttress 10a includes at least one sensing fiber 20
(FIG. 3). In some embodiments, the surgical buttress 11 is
configured the same as, or similar to, surgical implant 10 or 10a
(FIGS. 1-2, respectively).
In embodiments, the sensing fiber 20 of the surgical buttress 11 is
configured to measure a physiological parameter of interest related
to monitoring for anastomosis leakage about a staple line. In some
embodiments, the sensing fiber 20 is an optical pH sensor adapted
to measure changes in pH in the tissue environment adjacent the
staple line. In some embodiments, the sensing fiber 20 is a
chemical sensor adapted to detect the presence of an analyte
indicative of anastomotic leakage. The analyte to be detected can
be an endogenous material that would normally only be present
within a patient's body (e.g., intestines, etc.) such as E. coli or
blood, or an exogenous material introduced into the patient's body
and that remains within the body unless leakage occurs.
As shown in FIG. 5, during use of the surgical stapling apparatus
100, the anvil assembly 140 and the staple cartridge assembly 150,
which have each been loaded with a surgical buttress 11, are
positioned on opposed sides of a surgical site where adjacent first
and second layers of tissue "T" are to be fastened to one
another.
As shown in FIG. 6, the staple cartridge 154 includes surgical
staples 156 positioned within individual staple pockets 158. The
staples 156 are of a conventional type with each including a
backspan 156a and a pair of legs 156b extending from the backspan
156a and terminating in tissue penetrating tips 156c. Staple
pushers 160 are located within the staple pockets 158 and are
positioned between the staples 156 and the path of a drive bar
162.
The surgical stapling apparatus 100 is initially actuated by
movement of the trigger 112 (FIG. 4) relative to handle assembly
110 causing the driver 116 to move distally against a sloped edge
142a of the anvil jaw member 142 thereby causing the anvil jaw
member 142 to be moved to the closed position relative to receiving
jaw member 152 of the staple cartridge assembly 150. As the drive
bar 162 advances distally within the staple cartridge 154, the
drive bar 162 urges the staple pushers 160 upwardly against the
backspan 156a of the staples 156 driving the legs 156b of the
staples 156 through the surgical buttress 11 associated with the
staple cartridge assembly 150, the tissue "T", the surgical
buttress 11 associated with the anvil assembly 140, and towards
staple forming pockets 144 defined in the anvil jaw member 142. The
tissue penetrating tips 156c of the legs 156b of the staples 156
are bent within the staple forming pockets 144 of the anvil jaw
member 142 such that the backspan 156a and the legs 156b secure the
surgical buttresses 11 against the tissue "T".
Upon full actuation of surgical stapling apparatus 100, a knife 118
defining a knife blade 119, which is carried by the driver 116,
cuts the tissue "T" between the rows of now formed staples 156.
Upon movement of the anvil assembly 140 to the open position spaced
apart from the staple cartridge assembly 150, the surgical
buttresses 11 are pulled away from the anvil and staple cartridge
assemblies 140, 150.
The resulting tissue "T", divided and stapled closed with the
staples 156, is illustrated in FIG. 7. Specifically, the surgical
buttress 11 that was associated with the staple cartridge assembly
150 is secured against the tissue "T" by the backspans 156a of the
staples 156 and the surgical buttress 11 associated with the anvil
assembly 140 is secured against the tissue "T" by the legs 156b of
the staples 156. Thus, the surgical buttresses 11 are stapled to
the tissue "T" thereby sealing and reinforcing the staple lines
created by the staples 156, as well as allowing a clinician to
monitor properties on each side of, and through, the stapled tissue
"T" via the sensing fiber(s) 20 (FIG. 3) of the surgical buttresses
11. As discussed above, the sensing fibers 20 transmit information
to the clinician such that if a specified test criterion is met, a
course of treatment may be selected, e.g., antibiotic therapy,
surgical intervention, etc. On the other hand, if no indicator of
an abnormal physiological condition or state is provided, no
further action is required on the part of the clinician.
Referring now to FIGS. 8 and 9, an annular surgical stapling
apparatus 200, for use with a surgical buttress of the present
disclosure, is shown. The surgical stapling apparatus 200 includes
a handle assembly 210, an elongate tubular body portion 220
extending distally from the handle assembly 210, and an end
effector 230 disposed at a distal end of the elongate tubular body
portion 220. The handle assembly 210 has at least one pivotable
actuating handle member 212, and an advancing member 214. The
elongate tubular body portion 220 terminates in a staple cartridge
assembly 250 of the end effector 230 which includes a pair of
annular arrays of staple receiving slots 252 having a staple 254
disposed in each one of the staple receiving slots 252. Positioned
distally of the staple cartridge assembly 250 is an anvil assembly
240 of the end effector 230 which includes an anvil member 242 and
a shaft 244 operatively associated therewith for removably
connecting the anvil assembly 240 to a distal end portion of the
elongate tubular body portion 220 of the surgical stapling
apparatus 200.
The staple cartridge assembly 250 may be fixedly connected to the
distal end of the elongate tubular body portion 220 or may be
configured to concentrically fit within the distal end of the
elongate tubular body portion 220. The staple cartridge assembly
250 includes a staple pusher 256 including a proximal portion
having a generally frusto-conical shape and a distal portion
defining two concentric rings of peripherally spaced fingers (not
shown), each one of which is received within a respective staple
receiving slot 252.
A knife 258, substantially in the form of an open cup with the rim
thereof defining a knife blade 259, is disposed within the staple
cartridge assembly 250 and mounted to a distal surface of the
staple pusher 256. The knife 258 is disposed radially inward of the
pair of annular arrays of staples 254. Accordingly, in use, as the
staple pusher 256 is advanced, the knife 258 is also advanced
axially outward.
A surgical buttress 11a is releasably attached to the anvil
assembly 240 and/or the staple cartridge assembly 250. As
specifically shown in FIG. 10, the surgical buttress 11a is
provided in an annular configuration and includes a body portion
12' defining an aperture 13 that is sized and dimensioned to
receive the shaft 244 (FIG. 9) of the anvil assembly 240 and allow
free passage of the knife 258 (FIG. 9) therethrough. The body
portion 12' of the surgical buttress 11a may be configured as one
or more porous and/or non-porous layers as described above with
regard to surgical buttress 11, and which includes at least one
sensing fiber 20 (FIG. 3) disposed therein, as also described
above.
Referring again to FIG. 9, the surgical stapling apparatus 200 and
detachable anvil assembly 240 are used in an anastomosis procedure
to effect joining of intestinal sections. The anastomosis procedure
is typically performed using minimally invasive surgical techniques
including laparoscopic means and instrumentation. The anvil
assembly 240 is applied to an operative site either through a
surgical incision or transanally and positioned within a first
intestinal tissue section "T1", and the elongate tubular body
portion 220 of the surgical stapling apparatus 200 is inserted
through a surgical incision or transanally into a second intestinal
tissue section "T2".
Thereafter, a clinician maneuvers the anvil assembly 240 until the
proximal end of shaft 244 is inserted into the distal end of the
tubular body portion 220 of the surgical stapling apparatus 200,
wherein a mounting structure (not shown) within the distal end of
tubular body portion 220 engages the shaft 244 of the anvil
assembly 240 to effect mounting. The anvil assembly 240 and the
tubular body portion 220 are then approximated to approximate the
first and second tissue sections "T1", "T2". The surgical stapling
apparatus 200 is then fired, firing the staples 254 through the
surgical buttresses 11a as well as the first and second tissue
sections "T1", "T2", effecting stapling of the first and second
tissue sections "T1", "T2" to one another and cutting of the first
and second tissue sections "T1", "T2" by the knife 258 to complete
the anastomosis. Upon movement of the anvil assembly 240 away from
the staple cartridge assembly 250, the surgical buttresses 11a are
pulled away from the anvil and staple cartridge assemblies 240,
250.
As described above, the surgical buttresses 11a are stapled to the
first and second tissue sections "T1", "T2" thereby sealing and
reinforcing the staple lines created by the staples 254, as well as
allowing a clinician to monitor properties on each side of, and
through, the stapled first and second tissue sections "T1", "T2"
via the sensing fiber(s) 20 (FIG. 3).
With reference now to FIG. 11, an exemplary embodiment of a
surgical implant of the present disclosure is discussed in terms of
a surgical mesh. The surgical mesh may be used to reinforce tissue,
and includes at least one sensing fiber for measuring a
physiological parameter of the tissue and/or tissue environment.
While the embodiment is directed to an abdominal wall hernia repair
procedure, it is envisioned that the principles of the present
disclosure are equally applicable to a range of soft tissue repair
procedures, such as to the gall bladder, appendix, lungs, etc.
As shown in FIG. 11, a surgical mesh 11b includes a porous layer
12'' having a fibrous structure including at least one sensing
fiber 20. The surgical mesh 11b may have any shape, size, and/or
dimension suitable for a particular surgical application, and is
fabricated from biocompatible material(s) that may be porous,
non-porous, or combinations thereof, as discussed above. In some
embodiments, the fibrous structure of the surgical mesh 11b may be
the same as, or similar to, surgical implant 10 (FIG. 1), and/or
may include additional layers similar to, or the same as, surgical
implant 10a (FIG. 2).
In embodiments, the sensing fiber 20 of the surgical mesh 11b is
configured to measure a physiological parameter of interest related
to monitoring conditions about a soft tissue defect, e.g.,
herniated tissue. In some embodiments, the sensing fiber 20 is a
mechanical sensor, an electrical sensor, or an optical sensor
adapted to measure a physical property of the tissue or the tissue
environment. For example, the sensing fiber 20 may be configured to
measure a load or force (e.g., strain) related to physical
activity, such as intra-abdominal pressure, on a hernia repair
site. As another example, the sensing fiber 20 may be configured to
measure displacement of a surgical mesh indicative of mesh
migration. In certain embodiments, the sensing fiber 20 is a strain
gauge (e.g., an optical strain gauge).
In some embodiments, the sensing fiber 20 of the surgical mesh 11b
is an optical sensor or a chemical sensor adapted to detect and/or
quantify an amount of a material or substance (e.g., a chemical, an
analyte, a byproduct, a metabolite, etc.) in tissue or the tissue
environment indicative of a post-surgical condition or state.
Accordingly, if the sensing fiber 20 detects the material or
substance to be above or below a pre-determined value or to fall
within a pre-defined range, a clinician and/or the patient is
alerted so that a proper course of action may be taken to
accelerate or optimize healing (e.g., to correct or balance the
condition). For example, the sensing fiber 20 may be configured to
measure nitrogen content as a biomarker for protein loss and/or
muscle wasting such that if nitrogen levels fall below a
pre-determined value, a clinician may administer an hGH treatment
by, e.g., subcutaneous injection, to improve nitrogen balance and
to maintain and/or increase muscle mass and/or strength.
The surgical mesh 11b may be introduced through a mesh deployment
device and placed over damaged tissue (e.g., a tissue defect).
Suitable devices include those shown and described, for example, in
commonly owned U.S. Pat. No. 5,370,650, entitled "Articulating Mesh
Deployment Apparatus," U.S. Pat. No. 8,317,808, entitled "Device
and Method for Rolling and Inserting a Prosthetic Patch into a Body
Cavity," U.S. Pat. No. 8,906,045, entitled "Articulating Patch
Deployment Device and Method of Use," U.S. Pat. No. 9,107,726,
entitled "Device and Method for Deploying and Attaching an Implant
to a Biological Tissue," and U.S. Pat. No. 9,655,709, entitled
"Mesh Deployment Devices and Kits," the entire contents of each of
which is incorporated herein by this reference.
The surgical mesh 11b is secured to healthy tissue "A", such as an
abdominal wall, surrounding a tissue defect "D" (shown in phantom)
by fasteners "S" to anchor the surgical mesh 11b to the tissue "A".
The fasteners "S" may be staples, sutures, tacks, anchors, among
other fixation devices within the purview of those skilled in the
art. The fasteners "S" may be retained within an end effector of a
surgical fastener delivery device and deployed therefrom to secure
the surgical mesh 11b to the tissue "A." Suitable fasteners and
surgical fastener delivery devices include those shown and
described, for example, in commonly owned U.S. Pat. No. 7,229,452,
entitled "Tack and Tack Applier," U.S. Pat. No. 7,866,526, entitled
"Apparatus for Applying Surgical Fasteners to Body Tissue," U.S.
Pat. No. 8,216,272, entitled "Absorbable Anchor for Hernia Mesh
Fixation," the entire contents of each of which is incorporated
herein by this reference.
The surgical mesh 11b is secured to the tissue "A" to reinforce the
tissue defect "D", as well as to allow a clinician to monitor
properties around the tissue defect "D" via the sensing fiber(s) 20
of the surgical mesh 11b. As discussed above, the sensing fibers 20
transmit information to the clinician such that if a specific test
criterion is met, a course of treatment may be selected, for
example, to minimize or reduce patient morbidity and/or to detect
or prevent post-operative repair failure.
Surgical instruments, such as the surgical staplers the mesh
deployment devices, and the surgical fastener delivery devices, and
the surgical implants usable therewith, described herein, may also
be configured to work with robotic surgical systems and what is
commonly referred to as "Telesurgery." Such systems employ various
robotic elements to assist the surgeon and allow remote operation
(or partial remote operation) of surgical instrumentation. Various
robotic arms, gears, cams, pulleys, electric and mechanical motors,
etc. may be employed for this purpose and may be designed with a
robotic surgical system to assist the surgeon during the course of
an operation or treatment. Such robotic systems may include
remotely steerable systems, automatically flexible surgical
systems, remotely flexible surgical systems, remotely articulating
surgical systems, wireless surgical systems, modular or selectively
configurable remotely operated surgical systems, etc.
The robotic surgical systems may be employed with one or more
consoles that are next to the operating theater or located in a
remote location. In this instance, one team of surgeons or nurses
may prep the patient for surgery and configure the robotic surgical
system with one or more of the instruments disclosed herein while
another surgeon (or group of surgeons) remotely controls the
instruments via the robotic surgical system. As can be appreciated,
a highly skilled surgeon may perform multiple operations in
multiple locations without leaving his/her remote console which can
be both economically advantageous and a benefit to the patient or a
series of patients.
The robotic arms of the surgical system are typically coupled to a
pair of master handles by a controller. The handles can be moved by
the surgeon to produce a corresponding movement of the working ends
of any type of surgical instrument (e.g., end effectors, graspers,
knifes, scissors, etc.) which may complement the use of one or more
of the embodiments described herein. The movement of the master
handles may be scaled so that the working ends have a corresponding
movement that is different, smaller or larger, than the movement
performed by the operating hands of the surgeon. The scale factor
or gearing ratio may be adjustable so that the operator can control
the resolution of the working ends of the surgical
instrument(s).
The master handles may include various sensors to provide feedback
to the surgeon relating to various tissue parameters or conditions,
e.g., tissue resistance due to manipulation, cutting or otherwise
treating, pressure by the instrument onto the tissue, tissue
temperature, tissue impedance, etc. As can be appreciated, such
sensors provide the surgeon with enhanced tactile feedback
simulating actual operating conditions. The master handles may also
include a variety of different actuators for delicate tissue
manipulation or treatment further enhancing the surgeon's ability
to mimic actual operating conditions.
Reference is made herein to U.S. Pat. No. 8,828,023 entitled
"Medical Workstation," the entire content of which is incorporated
herein by reference, for a more detailed discussion of the
construction and operation of an exemplary robotic surgical
system.
Persons skilled in the art will understand that the devices,
systems, and methods specifically described herein and illustrated
in the accompanying figures are non-limiting exemplary embodiments,
and that the description, disclosure, and figures should be
construed merely exemplary of particular embodiments. It is to be
understood, therefore, that the present disclosure is not limited
to the precise embodiments described, and that various other
changes and modifications may be effected by one skilled in the art
without departing from the scope or spirit of the disclosure.
Additionally, it is envisioned that the elements and features
illustrated or described in connection with one exemplary
embodiment may be combined with the elements and features of
another exemplary embodiment without departing from the scope of
the present disclosure, and that such modifications and variations
are also intended to be included within the scope of the present
disclosure. Accordingly, the subject matter of the present
disclosure is not to be limited by what has been particularly shown
and described.
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